To Dr. Caspar Wistar Washington, June 21, 1807

DEAR SIR,

-- I have a grandson, the son of Mr. Randolph, now
about 15 years of age, in whose education I take a lively interest.
His time has not hitherto been employed to the greatest advantage, a
frequent change of tutors having prevented the steady pursuit of any
one plan. Whether he possesses that lively imagination, usually
called genius, I have not had opportunities of knowing. But I think
he has an observing mind & sound judgment. He is assiduous, orderly,
& of the most amiable temper & dispositions. As he will be at ease
in point of property, his education is not directed to any particular
possession, but will embrace those sciences which give to retired
life usefulness, ornament or amusement. I am not a friend to placing
growing men in populous cities, because they acquire there habits &
partialities which do not contribute to the happiness of their after
life. But there are particular branches of science, which are not so
advantageously taught anywhere else in the U.S. as in Philadelphia.
The garden at the Woodlands for Botany, Mr. Peale's Museum for
Natural History, your Medical school for Anatomy, and the able
professors in all of them, give advantages not to be found elsewhere.
We propose, therefore, to send him to Philadelphia to attend the
schools of Botany, Natural History, Anatomy, & perhaps Surgery; but
not of Medicine. And why not of Medicine, you will ask? Being led
to the subject, I will avail myself of the occasion to express my
opinions on that science, and the extent of my medical creed. But,
to finish first with respect to my grandson, I will state the favor I
ask of you, which is the object of this letter.

Having been born & brought up in a mountainous & healthy
country, we should be unwilling he should go to Philadelphia until
the autumnal diseases cease. It is important therefore for us to
know, at what period after that, the courses of lectures in Natural
history, Botany, Chemistry, Anatomy & Surgery begin and end, and what
days or hours they occupy? The object of this is that we may be able
so to marshal his pursuits as to bring their accomplishment within
the shortest space practicable. I shall write to Doctor Barton for
information as to the courses of natural history & botany but not
having a sufficient acquaintance with professors of chemistry &
surgery, if you can add the information respecting their school to
that of your own, I shall be much obliged to you. What too are the
usual terms of boarding? What the compensations to professors? And
can you give me a conjectural estimate of other necessary expenses?
In these we do not propose to indulge him beyond what is necessary,
decent, & usual, because all beyond that leads to dissipation &
idleness, to which, at present, he has no propensities. I think Mr.
Peale has not been in the habit of receiving a boarder. His house &
family would, of themselves, be a school of virtue & instruction; &
hours of leisure there would be as improving as busy ones elsewhere.
But I say this only on the possibility of so desirable a location for
him, and not with the wish that the thought should become known to
Mr. Peale, unless some former precedent should justify it's
suggestion to him. I am laying a heavy tax on your busy time, but I
think your goodness will pardon it in consideration of it's bearing
on my happiness.

This subject dismissed, I may now take up that which it led to,
and further tax your patience with unlearned views of medicine;
which, as in most cases, are, perhaps, the more confident in
proportion as they are less enlightened.

We know, from what we see & feel, that the animal body in it's
organs and functions is subject to derangement, inducing pain, &
tending to it's destruction. In this disordered state, we observe
nature providing for the re-establishment of order, by exciting some
salutary evacuation of the morbific matter, or by some other
operation which escapes our imperfect senses and researches. She
brings on a crisis, by stools, vomiting, sweat, urine, expectoration,
bleeding, &c., which, for the most part, ends in the restoration of
healthy action. Experience has taught us, also, that there are
certain substances, by which, applied to the living body, internally
or externally, we can at will produce these same evacuations, and
thus do, in a short time, what nature would do but slowly, and do
effectually, what perhaps she would not have strength to accomplish.
Where, then, we have seen a disease, characterized by specific signs
or phenomena, and relieved by a certain natural evacuation or
process, whenever that disease recurs under the same appearances, we
may reasonably count on producing a solution of it, by the use of
such substances as we have found produce the same evacuation or
movement. Thus, fulness of the stomach we can relieve by emetics;
diseases of the bowels, by purgatives; inflammatory cases, by
bleeding; intermittents, by the Peruvian bark; syphilis, by mercury:
watchfulness, by opium; &c. So far, I bow to the utility of
medicine. It goes to the well-defined forms of disease, & happily,
to those the most frequent. But the disorders of the animal body, &
the symptoms indicating them, are as various as the elements of which
the body is composed. The combinations, too, of these symptoms are
so infinitely diversified, that many associations of them appear too
rarely to establish a definite disease; and to an unknown disease,
there cannot be a known remedy. Here then, the judicious, the moral,
the humane physician should stop. Having been so often a witness to
the salutary efforts which nature makes to re-establish the
disordered functions, he should rather trust to their action, than
hazard the interruption of that, and a greater derangement of the
system, by conjectural experiments on a machine so complicated & so
unknown as the human body, & a subject so sacred as human life. Or,
ifthe appearance of doing something be necessary to keep alive the
hope & spirits of the patient, it should be of the most innocent
character. One of the most successful physicians I have ever known,
has assured me, that he used more bread pills, drops of colored
water, & powders of hickory ashes, than of all other medicines put
together. It was certainly a pious fraud. But the adventurous
physician goes on, & substitutes presumption for knolege. From the
scanty field of what is known, he launches into the boundless region
of what is unknown. He establishes for his guide some fanciful
theory of corpuscular attraction, of chemical agency, of mechanical
powers, of stimuli, of irritability accumulated or exhausted, of
depletion by the lancet & repletion by mercury, or some other
ingenious dream, which lets him into all nature's secrets at short
hand. On the principle which he thus assumes, he forms his table of
nosology, arrays his diseases into families, and extends his curative
treatment, by analogy, to all the cases he has thus arbitrarily
marshalled together. I have lived myself to see the disciples of
Hoffman, Boerhaave, Stalh, Cullen, Brown, succeed one another like
the shifting figures of a magic lantern, & their fancies, like the
dresses of the annual doll-babies from Paris, becoming, from their
novelty, the vogue of the day, and yielding to the next novelty their
ephemeral favor. The patient, treated on the fashionable theory,
sometimes gets well in spite of the medicine. The medicine therefore
restored him, & the young doctor receives new courage to proceed in
his bold experiments on the lives of his fellow creatures. I believe
we may safely affirm, that the inexperienced & presumptuous band of
medical tyros let loose upon the world, destroys more of human life
in one year, than all the Robinhoods, Cartouches, & Macheaths do in a
century. It is in this part of medicine that I wish to see a reform,
an abandonment of hypothesis for sober facts, the first degree of
value set on clinical observation, and the lowest on visionary
theories. I would wish the young practitioner, especially, to have
deeply impressed on his mind, the real limits of his art, & that when
the state of his patient gets beyond these, his office is to be a
watchful, but quiet spectator of the operations of nature, giving
them fair play by a well-regulated regimen, & by all the aid they can
derive from the excitement of good spirits & hope in the patient. I
have no doubt, that some diseases not yet understood may in time be
transferred to the table of those known. But, were I a physician, I
would rather leave the transfer to the slow hand of accident, than
hasten it by guilty experiments on those who put their lives into my
hands. The only sure foundations of medicine are, an intimate
knolege of the human body, and observation on the effects of
medicinal substances on that. The anatomical & clinical schools,
therefore, are those in which the young physician should be formed.
If he enters with innocence that of the theory of medicine, it is
scarcely possible he should come out untainted with error. His mind
must be strong indeed, if, rising above juvenile credulity, it can
maintain a wise infidelity against the authority of his instructors,
& the bewitching delusions of their theories. You see that I
estimate justly that portion of instruction which our medical
students derive from your labors; &, associating with it one of the
chairs which my old & able friend, Doctor Rush, so honorably fills, I
consider them as the two fundamental pillars of the edifice. Indeed,
I have such an opinion of the talents of the professors in the other
branches which constitute the school of medicine with you, as to hope
& believe, that it is from this side of the Atlantic, that Europe,
which has taught us so many other things, will at length be led into
sound principles in this branch of science, the most important of all
others, being that to which we commit the care of health & life.

I dare say, that by this time, you are sufficiently sensible
that old heads as well as young, may sometimes be charged with
ignorance and presumption. The natural course of the human mind is
certainly from credulity to scepticism; and this is perhaps the most
favorable apology I can make for venturing so far out of my depth, &
to one too, to whom the strong as well as the weak points of this
science are so familiar. But having stumbled on the subject in my
way, I wished to give a confession of my faith to a friend; & the
rather, as I had perhaps, at time, to him as well as others,
expressed my scepticism in medicine, without defining it's extent or
foundation. At any rate, it has permitted me, for a moment, to
abstract myself from the dry & dreary waste of politics, into which I
have been impressed by the times on which I happened, and to indulge
in the rich fields of nature, where alone I should have served as a
volunteer, if left to my natural inclinations & partialities.